意外胆囊癌34例临床分析

Clinic analysis of unexpected gallbladder caricinoma:report of 34 cases

目的总结胆囊切除术意外胆囊癌发生的特点,探讨其术前漏诊原因、方法及预防转移复发的对策。方法回顾性分析2001年1月~2006年12月期间该院开腹及腹腔镜胆囊切除术中或术后发现的34例意外胆囊癌的临床资料及随访结果。结果Nevein分期：Ⅰ期~Ⅱ期15例,Ⅲ期~Ⅴ期19例。术中发现10例,术后发现24例。26例行胆囊癌根治术,术后1、2、3年累积生存率分别为76.9%、53.8%、19.2%;仅行胆囊切除术的7例术后1年累积生存率为42.9%,无存活超过2年。1例行姑息性手术。结论对具有胆囊癌高危因素的患者,术前应详细分析各项检查结果,术中应仔细剖检胆囊;怀疑胆囊癌时应术中对标本行冰冻切片检查以明确诊断。确诊胆囊癌后,应早期行根治性切除并采取必要措施预防切口转移。

Aim To analyze clinical characters of unexpected gallbladder carcinoma（UGC） in cholecystectomy and to discuss the methods of avoiding loss of diagnosis and improving the treatment.Methods From January 2001 to December 2006,we performed a retrospective analysis of 34 patients who were treated in our hospital for UGC during or after cholecystectomy.Results Among the 34 cases of UGC,10 cases were diagnosed intraoperatively,and 24 cases were diagnosed postoperatively.According to Nevin classification,15 cases were stage I to stage II,and 19 cases were stage III to stage V.Radical cholecystectomy was performed on 26 cases,and only cholecystectomy was carried out in 7 cases.Just 1 patient was performed palliative surgery.The 1-,2-,3-year overall cumulative survival rate were 76.9%,53.8%,19.2% respectively in the radical cholecystectomy group.Whereas,in the 7 patients who only underwent cholecystectomy,the 1-year survival rate was 42.9%;moreover,none of the 7 patients survived for more than 2 years.Conclusion For high risk population,analyzing preoperative clinical data of patients,palpating the specimen carefully,and frozen section examination for any suspicion of cancer seem to be useful for the diagnosis of UGC.Standard radical resection should be performed immediately once the diagnosis is confirmed.It is also important for practitioners to stick to the principles of non-tumor manipulation during operation.